• Paediatric Buruli ulcer in Australia

      Walker, G; Friedman, D; Cooper, C; O'Brien, M; McDonald, A; Callan, P; O'Brien, D; MSF UK Manson Unit (2019-12-10)
      AIM: This study describes an Australian cohort of paediatric Buruli ulcer (BU) patients and compares them with adult BU patients. METHODS: Analysis of a prospective cohort of all BU cases managed at Barwon Health, Victoria, from 1 January 1998 to 31 May 2018 was performed. Children were defined as ≤15 years of age. RESULTS: A total of 565 patients were included: 52 (9.2%) children, 289 (51.2%) adults aged 16-64 years and 224 (39.6%) adults aged ≥65 years. Among children, half were female and the median age was 8.0 years (interquartile range 4.8-12.3 years). Six (11.5%) cases were diagnosed from 2001 to 2006, 14 (26.9%) from 2007 to 2012 and 32 (61.5%) from 2013 to 2018. Compared to adults, children had a significantly higher proportion of non-ulcerative lesions (32.7%, P < 0.001) and a higher proportion of severe lesions (26.9%, P < 0.01). The median duration of symptoms prior to diagnosis was shorter for children compared with adults aged 16-64 years (42 vs. 56 days, P = 0.04). Children were significantly less likely to experience antibiotic complications (6.1%) compared with adults (20.6%, P < 0.001), but had a significantly higher rate of paradoxical reactions (38.8%) compared with adults aged 16-64 (19.2%) (P < 0.001). Paradoxical reactions in children occurred significantly earlier than in adults (median 17 vs. 56 days, P < 0.01). Cure rates were similarly high for children compared to adults treated with antibiotics alone or with antibiotics and surgery. CONCLUSIONS: Paediatric BU cases in Australia are increasing and represent an important but stable proportion of Australian BU cohorts. Compared with adults, there are significant differences in clinical presentation and treatment outcomes.
    • Painless: a case of congenital insensitivity to pain in a 5-year-old male

      Al Amroh, HH; Reyes, AL; Barret Austin Hillary, J; Al Khaffaf, WH (Oxford University Press, 2020-07-24)
      Background: several genetic disorders are known to be associated with congenital insensitivity to pain (CIP), a term often used to describe an impaired ability to perceive the type, intensity and quality of noxious stimuli. Children with CIP often injure themselves severely. The injury can go unnoticed or be misdiagnosed as child abuse because it is associated with multiple and recurrent injuries which may result in permanent damage. Patient findings: we report the case of a 5-year-old boy with a history of showing no signs of pain when exposed to accidental injuries such as trauma, burns or secondary chronic lesions. Conclusion: child abuse has a much higher occurrence rate than rare neuropathies such as the one we describe. However, CIP should be considered as a diagnosis in any child presenting with a history of poor or absent responses to painful stimuli.
    • Patterns of deliberate self-burning in various parts of the world. A review.

      Laloë, V; Médecins Sans Frontières, 8 rue Saint-Sabin, 75544 Paris 11, France. veronique.laloe@bigfoot.com (Elsevier, 2004-05)
      This paper reviews the literature on deliberate self-burning (DSB) and compares patterns in various countries. Fifty-five studies of deliberate self-harm or suicide by fire published in the last 20 years were reviewed. They reported on 3351 cases of DSB, including 2296 deaths. India had the highest absolute number of cases, the highest fatality rate, and the highest contribution of self-harm to burns admissions. The highest reported incidence was from Sri Lanka. Male victims generally predominated in Western countries, and females in the Middle East and the Indian sub-continent. Patients were grossly 10 years older in Europe than in Asia. The use and nature of fire accelerants, the possible roles of ethnicity, religion/faith and imitation are discussed. Three broad groups of victims were identified: psychiatric patients (Western and Middle-Eastern countries); those committing DSB for personal reasons (India, Sri Lanka, Papua-New Guinea, Zimbabwe); and those who are politically motivated (India, South Korea). Self-mutilators and self-immolators seem to be fairly distinct groups of people.
    • Personal Protective Equipment for Filovirus Epidemics: A Call for Better Evidence

      Sprecher, Armand G; Caluwaerts, An; Draper, Mike; Feldmann, Heinz; Frey, Clifford P; Funk, Renée H; Kobinger, Gary; Le Duc, James W; Spiropoulou, Christina; Williams, Warren Jon (Oxford University Press, 2015-03-27)
      Personal protective equipment (PPE) is an important part of worker protection during filovirus outbreaks. The need to protect against a highly virulent fluid-borne pathogen in the tropical environment imposes a heat stress on the wearer that is itself a safety risk. No evidence supports the choice of PPE employed in recent outbreaks, and standard testing procedures employed by the protective garment industry do not well simulate filovirus exposure. Further research is needed to determine the appropriate PPE for filoviruses and the heat stress that it imposes.
    • Perspectives from MSF snakebite programme implementation in Agok, Abyei region, South Sudan

      Said, M; Valdespino, E; Baba, SP; Lako, R; Malm, A; Gonzalez, A; Alcoba, G (South Sudan Medical Journal, 2020-11-01)
      Introduction: Snakebite is a neglected tropical disease affecting around five million people, causing more than 100,000 annual deaths, as well as serious disabilities; however, access to antivenom and high-quality programmatic care remain a global challenge. Objective: Due to the high burden of snakebite in South Sudan and the serious negative outcomes if left untreated, Médecins Sans Frontières (MSF) integrated snakebite care for the first time among its priorities and consolidated a programme in Agok Hospital. Method: We describe the history, implementation, and challenges of the MSF snakebite programme. Results: The number of snakebite patients at MSF Agok Hospital has increased each year. From 2013 to 2019, MSF treated 2,005 snakebite patients. In 2019 there were 527 snakebite admissions, 47% presented with severe envenomation, and one death. Puff adders, vipers and various cobras were identified. Agok Hospital gained understanding on the barriers and facilitators for the population to access care after a snakebite. MSF developed “snakebite diagnosis and treatment” algorithms, and provided clinical training, with the validation of national health authorities. Preventive activities were reinforced. Integration of surgical services was an essential programmatic aspect to monitor and treat complications. Challenges for implementation included a lack of easily available antivenoms in the international market. and the need of a strong supply chain and procurement systems. Conclusion: The delivery of healthcare towards snakebite patients can be successfully implemented when prioritized. Global efforts to improve access and quality of antivenoms and snakebite care could help removing Snakebite Envenoming from the Neglected Tropical Diseases list.
    • Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo

      Mancini, Silvia; Coldiron, Matthew E; Nicholas, Sarala; Llosa, Augusto E; Mouniaman-Nara, Isabelle; Ngala, Joseph; Grais, Rebecca F; Porten, Klaudia (BioMed Central, 2014-10-23)
      A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.
    • Plant poisoning outbreak in the western area of Cambodia, 2005

      Tourdjman, M; Srihawong, R; Soy, T Khean; Touch, S; Hul, S; Janssens, B; Galliot-Guilley, M; Vong, S; Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Médecins Sans Frontières Belgium, Phnom Penh, Cambodia; Ministry of Health, Phnom Penh, Cambodia; Muséum National d’Histoire Naturelle, Paris, France; Service de Toxicologie, Hôpital Lariboisière, Paris, France (2009-03-01)
      An outbreak investigation was conducted during February-March 2005 to determine the cause of several sudden deaths occurring in Pailin Province, Cambodia. Sixty-seven patients presented with non-febrile poisoning-like symptoms and 15 died of coma, including 53% children under 10 years old. Symptoms included sore throat (92%), sore lips (73%), swollen tongue (54%) and gastrointestinal signs (41%). A plant locally called prik was the source of poisoning (97.0 vs. 28.7%, odds ratio 74.3, P<0.001). Patients may have confused the edible Melientha suavis Pierre with Urobotrya siamensis Hiepko, both from the Opiliaceae family. This was the first report of Urobotrya poisoning and its clinical manifestations.
    • Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus-Infected Patients

      Rosenke, K; Adjemian, J; Munster, VJ; Marzi, A; Falzarano, D; Onyango, CO; Ochieng, M; Juma, B; Fischer, RJ; Prescott, JB; et al. (2016-08-15)
       The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus.
    • Point-of-Care Approaches for Meningitis Diagnosis in a Low-Resource Setting (Southwestern Uganda): Observational Cohort Study Protocol of the “PI-POC” Trial

      Gaudenzi, G; Kumbakumba, E; Rasti, R; Nanjebe, D; Reu, P; Nyehangane, D; Martensson, A; Nassejje, M; Karlsson, J; Mzee, J; et al. (JMIR Publications, 2020-11-04)
      Background: A timely differential diagnostic is essential to identify the etiology of central nervous system (CNS) infections in children, in order to facilitate targeted treatment, manage patients, and improve clinical outcome. Objective: The Pediatric Infection-Point-of-Care (PI-POC) trial is investigating novel methods to improve and strengthen the differential diagnostics of suspected childhood CNS infections in low-income health systems such as those in Southwestern Uganda. This will be achieved by evaluating (1) a novel DNA-based diagnostic assay for CNS infections, (2) a commercially available multiplex PCR-based meningitis/encephalitis (ME) panel for clinical use in a facility-limited laboratory setting, (3) proteomics profiling of blood from children with severe CNS infection as compared to outpatient controls with fever yet not severely ill, and (4) Myxovirus resistance protein A (MxA) as a biomarker in blood for viral CNS infection. Further changes in the etiology of childhood CNS infections after the introduction of the pneumococcal conjugate vaccine against Streptococcus pneumoniae will be investigated. In addition, the carriage and invasive rate of Neisseria meningitidis will be recorded and serotyped, and the expression of its major virulence factor (polysaccharide capsule) will be investigated. Methods: The PI-POC trial is a prospective observational study of children including newborns up to 12 years of age with clinical features of CNS infection, and age-/sex-matched outpatient controls with fever yet not severely ill. Participants are recruited at 2 Pediatric clinics in Mbarara, Uganda. Cerebrospinal fluid (for cases only), blood, and nasopharyngeal (NP) swabs (for both cases and controls) sampled at both clinics are analyzed at the Epicentre Research Laboratory through gold-standard methods for CNS infection diagnosis (microscopy, biochemistry, and culture) and a commercially available ME panel for multiplex PCR analyses of the cerebrospinal fluid. An additional blood sample from cases is collected on day 3 after admission. After initial clinical analyses in Mbarara, samples will be transported to Stockholm, Sweden for (1) validation analyses of a novel nucleic acid–based POC test, (2) biomarker research, and (3) serotyping and molecular characterization of S. pneumoniae and N. meningitidis. Results: A pilot study was performed from January to April 2019. The PI-POC trial enrollment of patients begun in April 2019 and will continue until September 2020, to include up to 300 cases and controls. Preliminary results from the PI-POC study are expected by the end of 2020. Conclusions: The findings from the PI-POC study can potentially facilitate rapid etiological diagnosis of CNS infections in low-resource settings and allow for novel methods for determination of the severity of CNS infection in such environment.
    • Poliomyelitis outbreak, Pointe-Noire, Republic of the Congo, September 2010-February 2011.

      Le Menach, Arnaud; Llosa, Augusto E; Mouniaman-Nara, Isabelle; Kouassi, Felix; Ngala, Joseph; Boxall, Naomi; Porten, Klaudia; Grais, Rebecca F; Health Protection Agency, London, UK. (2011-08)
      On November 4, 2010, the Republic of the Congo declared a poliomyelitis outbreak. A cross-sectional survey in Pointe-Noire showed poor sanitary conditions and low vaccination coverage (55.5%), particularly among young adults. Supplementary vaccination should focus on older age groups in countries with evidence of immunity gaps.
    • Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014

      Azman, AS; Rumunu, J; Abubakar, A; West, H; Ciglenecki, I; Helderman, T; Wamala, JF; Vázquez, OR; Perea, W; Sack, DA; et al. (Center for Disease Control, 2016-06-01)
      Following mass population displacements in South Sudan, preventive cholera vaccination campaigns were conducted in displaced persons camps before a 2014 cholera outbreak. We compare cholera transmission in vaccinated and unvaccinated areas and show vaccination likely halted transmission within vaccinated areas, illustrating the potential for oral cholera vaccine to stop cholera transmission in vulnerable populations.
    • Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016.

      Fily, F; Ronat, JB; Malou, N; Kanapathipillai, R; Seguin, C; Hussein, N; Fakhri, RM; Langendorf, C (BioMed Central, 2019-01-31)
      War-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans Frontières (MSF) in Amman, Jordan, and to identify risk factors for developing PTO with FLAR bacteria.
    • Practical Field Epidemiology to Investigate a Cholera Outbreak in a Mozambican Refugee Camp in Malawi, 1988.

      Moren, A; Stefanaggi, S; Antona, D; Bitar, D; Etchegorry, M G; Tchatchioka, M; Lungu, G; Epicentre, Paris, France. (1991-02)
      Of all populations affected by cholera, refugees are at particular risk of infection due to overcrowding and poor sanitation. Between 15 March and 17 May 1988, 951 cases of cholera were registered at the cholera treatment centre in a Mozambican refugee camp in Malawi. The epidemic duration was 65 days. Vibrio cholerae biotype E1 Tor serotype Inaba was isolated. To identify high-risk groups and potential risk of acquiring the disease, an epidemiologic investigation was conducted. The attack rate of recorded cases was 2.6% with a range from 0.9 to 5.1% for different sections of the camp. The case fatality rate was 3.3% and decreased from week 1 to week 6. The epidemic started in the section near the market place and radiated out. A matched-pair case-control study of food and water consumption was performed early in the outbreak. It showed that cases were more likely to use shallow wells (surface wells) instead of boreholes compared to controls (OR = 4.5, CI = 1.0-20.8, P = 0.04) and that cases were more likely to have had contact with the market than controls (OR = 3.5, CI = 0.7-16.8, P = 0.09). None of the food items available at the market was more likely to be preferred by cases than controls. Recommendations included early case finding and treatment, temporary closure of the market, tetracycline prophylaxis of contacts, and water chlorination.
    • Pre-emptive steroids for a severe oedematous Buruli ulcer lesion: a case report

      O'Brien, Daniel P; Huffam, Sarah (BioMed Central, 2015-05-01)
      Severe oedematous forms of Buruli ulcer (BU) often result in extensive tissue destruction, even with the institution of appropriate antibiotic treatment, leading to reconstructive surgery and long-term disability. We report a case of a patient with severe oedematous BU, which describes for the first time the pre-emptive use of prednisolone therapy commenced at the time of antibiotic initiation aimed at limiting the ongoing tissue destruction and its secondary sequelae.
    • Prediction of Cholera Dynamics in Haiti Following the Passage of Hurricane Matthew

      Camacho, A; Cohuet, S; Grandesso, F; Luquero, F; Lynch, E; Pasetto, D; Finger, F; Bertuzzo, E; Rinaldo, A (Ecole Polytechnique Federale de Lausanne, 2016-12)
      Following the landfall of Hurricane Matthew in Haiti on October 3, 2016, an increase of suspected cholera cases was reported in both the southern part of the island (with Grande-Anse and Le Sud departments reporting 1349 and 1533 cases respectively between 5 October and 6 November) and also in the capital, Port-au-Prince (438 cases reported over the same period). The hurricane caused the displacement of about 175,000 people, the vast majority of which remained in their department of origin; however, about 10% appear to have displaced to the capital Port-au-Prince. In this context, a mass OCV vaccination campaign was planned, starting on November 8 and targeting 816,999 individuals in Grande-Anse and Le Sud. The aim of this study is to provide additional information to health actors responding to the post-hurricane cholera outbreak in Haiti. To this end, we calibrated a mechanistic model of cholera transmission on currently available data for Haiti in order to forecast the spatio-temporal dynamics of the cholera epidemic at the departmental level from November 2016 to January 2017. Model outputs have been translated into operational recommendations, with a focus on the scheduled OCV campaign.
    • Prevalence and correlates of MRSA and MSSA nasal carriage at a Ugandan regional referral hospital

      Bebell, LM; Ayebare, A; Boum, Y; Siedner, MJ; Bazira, J; Schiff, SJ; Metlay, JP; Bangsberg, DR; Ttendo, S; Firth, PG (Oxford University Press, 2016-12-15)
      Despite increasing antimicrobial resistance globally, data are lacking on prevalence and factors associated with Staphylococcus aureus (SA) and MRSA carriage in resource-limited settings.
    • Prevalence and risk factors of brucellosis among febrile patients attending a community hospital in south western Uganda

      Migisha, R; Dan N; Boum, Y; Page, AL; Zúñiga-Ripa, A; Conde-Álvarez, R; Bagenda, F; Bonnet, M (Nature Research, 2018-10-18)
      Human brucellosis, a chronic disease contracted through contact with animals and consuption of unpasteurized dairy products is underreported in limited-resource countries. This cross-sectional study aimed to determine the prevalence and risk factors of brucellosis among febrile patients attending a community hospital in South western Uganda. A questionnaire that captured socio-demographic, occupational and clinical data was administered. Blood samples were tested for Brucella antibodies using Rose Bengal Plate Test (RBPT) and blood culture with standard aerobic BACTEC bottle was done. Of 235 patients enrolled, prevalence of brucellosis (RBPT or culture confirmed) was 14.9% (95% CI 10.6-20.1) with a culture confrmation in 4.3% of the participants. The factors independently associated with brucellosis were consumption of raw milk (aOR 406.15, 95% CI 47.67-3461.69); history of brucellosis in the family (aOR 9.19, 95% CI 1.98-42.54); and selling hides and skins (aOR 162.56, 95% CI 2.86-9256.31). Hepatomegaly (p < 0.001), splenomegaly (p = 0.018) and low body mass index (p = 0.032) were more common in patients with brucellosis compared to others. Our findings reveal a high prevalence of brucellosis among febrile patients and highlight a need for implementing appropiate tests, public awareness activities and vaccination of animals to control and eliminate the disease.
    • Prevalence and risk factors of Lassa seropositivity in inhabitants of the forest region of Guinea: a cross-sectional study.

      Kernéis, Solen; Koivogui, Lamine; Magassouba, N'Faly; Koulemou, Kekoura; Lewis, Rosamund; Aplogan, Aristide; Grais, Rebecca F; Guerin, Philippe J; Fichet-Calvet, Elisabeth; Epicentre, Paris, France. solen.kerneis@cch.aphp.com (2009-11)
      BACKGROUND: Lassa fever is a viral hemorrhagic fever endemic in West Africa. The reservoir host of the virus is a multimammate rat, Mastomys natalensis. Prevalence estimates of Lassa virus antibodies in humans vary greatly between studies, and the main modes of transmission of the virus from rodents to humans remain unclear. We aimed to (i) estimate the prevalence of Lassa virus-specific IgG antibodies (LV IgG) in the human population of a rural area of Guinea, and (ii) identify risk factors for positive LV IgG. METHODS AND FINDINGS: A population-based cross-sectional study design was used. In April 2000, all individuals one year of age and older living in three prefectures located in the tropical secondary forest area of Guinea (Gueckedou, Lola and Yomou) were sampled using two-stage cluster sampling. For each individual identified by the sampling procedure and who agreed to participate, a standardized questionnaire was completed to collect data on personal exposure to potential risk factors for Lassa fever (mainly contact with rodents), and a blood sample was tested for LV IgG. A multiple logistic regression model was used to determine risk factors for positive LV IgG. A total of 1424 subjects were interviewed and 977 sera were tested. Prevalence of positive LV Ig was of 12.9% [10.8%-15.0%] and 10.0% [8.1%-11.9%] in rural and urban areas, respectively. Two risk factors of positive LV IgG were identified: to have, in the past twelve months, undergone an injection (odds ratio [OR] = 1.8 [1.1-3.1]), or lived with someone displaying a haemorrhage (OR = 1.7 [1.1-2.9]). No factors related to contacts with rats and/or mice remained statistically significant in the multivariate analysis. CONCLUSIONS: Our study underlines the potential importance of person-to-person transmission of Lassa fever, via close contact in the same household or nosocomial exposure.
    • Prevalence and vaccination coverage of Hepatitis B among healthcare workers in Cameroon: A national seroprevalence survey

      Bilounga Ndongo, C; Eteki, L; Siedner, M; Mbaye, R; Chen, J; Ntone, R; Donfack, O; Bongwong, B; Essaka, RE; Zeh, F; et al. (Wiley-Blackwell, 2018-07-26)
      Hepatitis B virus (HBV) infection is hyperendemic in Cameroon, and health care workers (HCWs) are at high-risk of infection. We aimed to assess prevalence, risk factors and vaccine coverage of HBV infection among HCWs in Cameroon. We conducted a cross-sectional study in 16 hospitals across all regions of Cameroon. HCWs were tested for HBV using rapid diagnostic tests (RDT). We collected data on socio-demographics and HBV vaccination status. We estimated prevalence of HBV and used Poisson regression models with robust standard errors to model the prevalence ratios of HBV positivity between covariates. We enrolled 1,824 of 1,836 eligible HCWs (97.5%). The mean age was 34 (SD: 10) years, 65.3% (n=1787) were women, and 11.4% (n=1747) had three or more doses of the HBV vaccine. Overall, we found a HBV prevalence of 8.7% (95% CI: 5.2 - 14.3%). Patient transporters had the highest crude prevalence (14.3%; 95%CI: 5.4-32.9%), whereas medical doctors had the lowest (3.2%; 95%CI: 0.8%-12.1%). The Far North Region had the highest prevalence of HBV (24.0%; 95%CI: 18.3%-30.8%). HBV prevalence decreased with increasing doses of the HBV vaccine (10.3% for no doses vs 3.5% for three or more doses; P<0.001). In conclusion, approximately 1 in 12 HCWs in Cameroon have evidence of HBV infection, yet fewer than 1 in 6 have been fully vaccinated. Our results illustrate the urgent need to scale up systematic HBV screening and targeted vaccination of HCWs in the region. This article is protected by copyright. All rights reserved.
    • Prevalence of Antibodies to Brucella Species in Commercial Raw Bovine Milk in Southwestern Uganda

      Kamwine, M; Orikiriza, P; Taseera, K; Iramiot, J; Ojuka, P; Ikiriza, S; Atwebembeire, J; Otieno, D; Tweshengyereze, S; Mwanga-Amumpaire, J; et al. (BioMed Central, 2017-09-08)
      The purpose and objective of this research was to explore the prevalence of antibodies against Brucella species in raw milk samples collected in Southwestern Uganda, one of the biggest milk producing regions in the Country. We hypothesized that there is a high level of antibodies in milk samples from this region. This builds more evidence to other studies in the region on the level contamination of raw milk.